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Original Research: LUNG CANCER |

Maintenance Therapy With Continuous or Switch Strategy in Advanced Non-small Cell Lung CancerMaintenance Therapy in Non-small Cell Lung Cancer: A Systematic Review and Meta-analysis

Xinji Zhang, PhD; Jiajie Zang, PhD; Jinfang Xu, PhD; Chong Bai, MD, PhD; Yingyi Qin, MASc; Ke Liu, PhD; Cheng Wu, PhD; Meijing Wu, PhD; Qian He, PhD; Shanshan Zhang, PhD; Lixin Wei, PhD; Jia He, PhD
Author and Funding Information

From the Department of Health Statistics (Drs X. Zhang, Zang, Xu, C. Wu, M. Wu, Q. He, and J. He and Mr Qin); Respiratory Department (Dr Bai), Changhai Hospital; Department of Medical Oncology (Dr Liu), Changzheng Hospital; and Tumor Immunology and Gene Therapy Center (Drs S. Zhang and Wei), Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.

Correspondence to: Jia He, PhD, Department of Health Statistics, Second Military Medical University, NO. 800 Xiangyin Rd,Yangpu District, Shanghai, China, 0086200433; e-mail: hejia63@yahoo.com


Drs X. Zhang, Zang, and Xu contributed equally to this study.

Funding/Support: Editorial support in the final preparation of the manuscript was provided by Editage, which was funded by the Ministry of Science and Technology of China [Grants 2009ZX09312-025, 2008ZX09312-007].

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians (http://www.chestpubs.org/site/misc/reprints.xhtml).


© 2011 American College of Chest Physicians


Chest. 2011;140(1):117-126. doi:10.1378/chest.10-2745
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Background:  Maintenance therapy for patients with non-small cell lung cancer (NSCLC) has gained extensive interest. Varying results for this treatment underpin the need for a synthesis of evidence.

Methods:  Trials investigating maintenance therapy with either a continuous or a switch strategy for patients with nonprogressing NSCLC compared with placebo or observation were identified. The primary outcome was overall survival (OS), and secondary outcomes included progression-free survival (PFS) and toxicity.

Results:  Eight trials of 3,736 patients were included in the analysis. Switch maintenance therapy substantially improved OS compared with placebo or observation (hazard ratio [HR], 0.85; 95% CI, 0.79-0.92; P < .001). A similar trend of improved OS was found in continuous maintenance therapy, despite lacking statistical significance (HR, 0.88; 95% CI, 0.74-1.04; P = .124). The interaction test suggested that the difference in OS between the two maintenance strategies was not statistically significant (P = .777). Clinically substantial and statistically significant improvement in PFS was found with both maintenance strategies (switch maintenance therapy HR, 0.67; 95% CI, 0.57-0.78; continuous maintenance therapy HR, 0.53; 95% CI, 0.43-0.65; interaction P = .128). Subgroup analyses revealed no statistically significant differences in OS or PFS between switch maintenance therapy with cytotoxic agents and that with tyrosine kinase inhibitor agents. Toxicity was greater in maintenance therapy.

Conclusions:  Maintenance therapy with either a continuous or a switch strategy significantly increases OS and PFS compared with placebo or observation. However, the benefits must be balanced against toxicity.

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